Session Title: Systemic Sclerosis & Related Disorders – Clinical Poster I
Session Type: Poster Session (Sunday)
Session Time: 9:00AM-11:00AM
Background/Purpose: The purpose of this pilot study is to identify, in a cohort of Systemic Sclerosis (SSc) patients, a “very early” nailfold videocapillaroscopy (NVC) pattern able to predict the evolution to the already defined NVC scleroderma-patterns (early (E), active (A), late (L), scleroderma-like (SL)).
Methods: We selected NVC images from 273 patients affected by SSc (according to 2013 ACR criteria) presenting one of the validated NVC scleroderma-patterns : 81 had an “E” pattern, 84 an “A” pattern, 92 a “L” pattern, 16 a “SL” pattern. Among the 273 SSc patients, 54 had a NVC analysis performed before the development of the “E” scleroderma-pattern; thus, we enrolled them for an accurate study of time of evolution and capillaroscopic characteristics. A detailed pilot study of NVC features was initially random performed on 10 of the 54 patients selected. Since we have previously demonstrated that capillary diameter over 30 μm is an independent predictor for development of SSc associated secondary Raynaud’s phenomenon (SRP) , the analysis included the number and the limbs diameters (arterial, venous, and apical) of capillaries with a diameter over 30 μm, together with the total number of capillaries and microhemorrhages, in 16 images per subject.
Results: The average time of evolution in a scleroderma-pattern was 4 years: 31 (57%) patients developed an “E” scleroderma-pattern in the following 3 years; over longer time, 6 (11%) patients evolved in “A” pattern in 4 years and 3 (6%) patients in “L” NVC pattern in 5 years; 14 (26%) patients developed a “Scleroderma-like” pattern in 4 years. All the 54 SSc patients (100%) showed enlarged capillaries with an average diameter over 30 μm in their previous NVC. The detailed pilot morphological study conducted on 10 patients at last non-specific NVC analysis revealed an average total number of capillaries of 8.6/mm. Capillaries with a diameter over 30 μm were 2.66 (31%); among these, the mean value diameter of the most dilated capillary was 35.74 μm (arterial 33.34 μm, apical 43.94 μm, venous 30 μm). The mean value for microhemorrhages was 0.6/mm. The mean number of capillaries reduced from 8.6±0.8 to 6.9±2.2/mm (p=0.01) during follow-up (4 years).
Conclusion: Present pilot study demonstrates for the first time that, before developing a validated NVC scleroderma-pattern, all SSc patients enrolled present a significant increase of nailfold capillary diameter over 30 μm at NVC. Together with the total number of dilated capillaries, the subsequent reduction in total number of capillaries (as shown at follow up) and the presence of microhemorrhages, it lets to identify a “Very Early” scleroderma pattern, able to intercept patients with SRP at higher risk of evolution in a validated SSc NVC pattern. A larger sample of patients is under investigations.
1.Cutolo et al. J Rheumatol 2000;27:155-60; 2.Trombetta et al. J Rheumatol 2016;43:599-606.
To cite this abstract in AMA style:Pendolino M, Pizzorni C, Paolino S, Tomatis V, Alessandri E, Sulli A, Goegan F, Smith V, Cutolo M. Looking for a “Very Early” Nailfold Capillaroscopic Pattern: Specific Alterations of Nailfold Capillaries May Precede the Validated Scleroderma-Patterns in Systemic Sclerosis Patients [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/looking-for-a-very-early-nailfold-capillaroscopic-pattern-specific-alterations-of-nailfold-capillaries-may-precede-the-validated-scleroderma-patterns-in-systemic-sclerosis-patients/. Accessed July 13, 2020.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/looking-for-a-very-early-nailfold-capillaroscopic-pattern-specific-alterations-of-nailfold-capillaries-may-precede-the-validated-scleroderma-patterns-in-systemic-sclerosis-patients/